Is "Hear no evil, see no evil, speak no evil" a good bird flu policy?

Michael Osterholm concludes each of his talks (those I've heard) with this statement, Whatever we do now to prepare is often viewed as expensive, difficult, inconveniencing and even alarmist. In hindsight, whatever we do now will be viewed as not enough. (my paraphrase)

The governments are penny pinching and pretending that somehow a magic 2% CFR will appear during pandemic phase 6. Meanwhile, this virus, everywhere in the world it has infected people, has had a CFR of 40% - 100%.

The governmental leaders have picked their poison. It's a CFR for Category 5 = 2%(plus?).

The challenge has been and remains answering now one question, "Is pandemic due to H5N1 inevitable?" The CDC has not to date undertaken a serious effort to determine the answer to this one question.

As a consequence, no motivation = no money = Osterholm's "not enough".

And the kicker that kicks this pandemic book shut is that the consequences of pandemic at 5%/10%/60% (the WHO number)/ and the real 80%+ are all visible, estimable and catastrophic.

Your post is a spotlight on the confusion in PH caused by the failure to address the question, "What is the statistical probability that H5N1 will become pandemic?"
The factors are known. The same effort was undertaken by CDC in the past for asian influenza. Their conclusions then were correct. Why doesn't the CDC haul out its formulas and apply them to H5N1?

I think the strategy is to identify and depend on a few reliable internet sources and check them frequently. Effect Measure plays a key role, perhaps more important than the Revere's themselves realise. Other sources I rely on are Promed and 'The Coming Pandemic' and Recombinomics. One still has to filter things, but these are the independent pros and I doubt they'll miss much. So, internet creates an information glut but also provides the social resources to deal with it.

GR: Your assumption that we can make a prediction of where and when and how much I consider to be wrong and naive and not borne out by the evidence. You are free to guess with the rest of us. I don't consider your guesses to be very objective but that's me. Others may differ on that. Where we are likely to be more in agreement is that it would be very prudent to invest heavily in a public health and social service infrastructure that could better handle a pandemic, whether of H5N1 or anything else, and make many other things better as well. But you might not agree with that because it would cost money. I don't know what you think about that since you are so fixated on flu (IMO).

Ron: I appreciate your confidence. I agree that all sources of info should be viewed critically. But not hypercritically, since radical skepticism is either uninformative (no information source is reliable or trustworthy) or biased (I'll see it when I believe it).

GR-Now I have to kind of go with Revere on this one... It might not come and he isnt incorrect when he says that there isnt convincing evidence. Its tantalizing for the doomsayers though. . My thing is that statistically speaking and with the graphics produced by our agenda based UN for GW, Natural Disasters etc that something pretty rough is coming. It might not be BF, but how about a mish mash of ugly? Its like I said in other posts, dont assume BF is going to get you. We might hear a rushing sound in the background as the tsunami sweeps the E. Coast of the US. Cascadia is out there too so any number of things could happen and statistically speaking we are due for several major things to happen singly, but now almost all together.

Why may not be a good question to ask. GW/Climate change? Might just be a place for them to hang their left wing hats on. One thing is sure we cant prove or disprove anything and the reasons for it other than 1 degree of warming.

Hear no evil, speak no evil... that is other than anything that sounds bad for this administration. Just like the report this morning that the have and have nots have increase 26% in the last 3 years with "Americans." Severe poverty rose to 16 million.... in Americans. Uh-huh. Turns out that those numbers included all of the Mexican illegals that were on the government dole too. They increased by 10 million in 3 years and I guarantee that living 10 to an apartment in E. LA or even in Memphis is ten times better than living in an adobe in Hermosilla or Torreon.

Now Revere DOES have it right about this administration about BF/pandemic response. Its sucky at best and really I dont know what anyone could do as the states will try to federalize it and then a very little agency will have to go with what they know and its to the military option. If it does, I want Lt. Gen Honore in charge from the beginning. He runs Camp Shelby in MS and was the General in charge of the Katrina pickup at day 5. It also was the day that Blanco the Blithering finally signed the order for federal disaster assistance. My biggest fear? The states do nothing and leave it to the USGOVT. Mustering of all of our forces wouldnt touch a tsunami on the West or East Coast. Nor would it for BF.

Like I said. Just get your little selves prepared for what is inevitable and go with the flow when it does. If it never comes....GOOD!

Where I live, we don't expect either the Feds or the State to help us. We know better and will rely on ourselves to get us thru a disaster/BF. Of course we can't do it all, but if every household is somewhat prepared, that is certainly better than nothing. More time before something happens hopefully will just give us more time to prepare and hopefully not get lethargic.

It could be suggested that what is required ab initio would be a true globally standardized protocol for diagnosis and clinical assessment.

The subject is both important and complex. Having casework done on a widely varying basis, without identical test and monitoring methodologies being applied in each individual circumstance, brings more statistical noise into the process right at the front end.

An old engineering rule: you can't control every variable, which makes it all the more important to control what you can.

Of course, we are then reliant upon the honesty and competence of local officialdom in assuring that said identical rules get applied. It is difficult to be sanguine about the prospects for this.

I note the recent crash of an Adam Air Boeing 737 in Indonesia, with the loss of all passengers and crew.

What has come out in the time since then have been a flood of revelations about Adam Air's operations. The firm has been in systematic violation of hundreds of directives pertaining to airworthiness, regularly flying planes which were in no sense fit to dispatch. This includes lack of weather radar. The disappeared Adam Air flight had been flying into the teeth of heavy thunderstorms.

The owners of the company are plausibly alleged to have been spending money to pay off inspectors rather than on maintaining their fleet, and when pilots have refused to fly these dangerous aircraft, those pilots have simply been sacked.

There is, of course, no connection between this state of affairs and the fact that one of the founding investors of Adam Air is the speaker of the Indonesian parliament.

--

At CDC Chatter the topic of panflu estimating arose. I'm merely an advocate for a serious review of this timely topic. http://www.cdcchatter.net/index.php?name=Comments&req=
showreply&tid=4172&sid=377&pid=4155&mode=thread&order=
0&thold=1#tid4172

It's quite simple. Until the question of inevitability is addressed, based on the obvious lack of interest by the world's populations and all but a handful of governments, and where there is interest, preparation being undertaken in anticipation of a 2% CFR or even 2% mortality within the entire population, there is no hard evidence or convincing logic to think that pandemic will occur.

The foolishness that a pandemic is "overdue" is not a rational basis to do more than tip one's hat to the issue and move along. That however is the argument presented by the Secretary of DHHS, and Osterholm as well. Their observation is irrational in any short time frame (one or two years).

So, what's left? Nothing. The influenza facts are as we all see, based on nearly no volume of infection or deaths.

While you consider and paint with a epidemiologically broader brush, I am focused on, and paint with a fine hair brush as I have been "naive" and "wrong" in thinking that the CFR has only a possibility of dropping and the consequences would be let's say of such an extent that your broad brush strokes immediately become irrelevant.

It's one thing to acknowledge there are unknowns. It's another to reject the possibility of man's capability to create forecasts. I think that's what you've decided. I for one quite enjoy believing that accuweather et al are more than talking heads.

As a businessman, I make probability decisions multiple times a day. What is being posited is that there will be value from the exercise. If you wish to reconsider, please post. I'll continue to advocate for more than what WHO has done, drive the pandemic influenza car forward by looking in the rear view mirror. It's not accurate, and it's reckless.

Until the study that I and others before me have requested, a serious attempt to determine the inevitability of an H5N1 pandemic, the sentinels are pissin' in the wind.

>http://www.foreignaffairs.org/20070301faessay86204/michael-
t-osterholm/unprepared-for-a-pandemic.html

Michael Osterholm, repeatedly, in his new Foreign Affairs article says, "No one can predict when the next pandemic will occur or how severe it will be."

That is a code phrase for "Nothing happening; low probability". It's the way human minds filter reality. They favor the easiest path of least thought. And by failure to conduct this intensive study, we, humankind, will reap the wind... if and when (there it is again...duh, I just don't know) H5N1 pandemic Phase 6 with a CFR of 85% appears. But who knows. See no evil. Speak no evil.

GR: Please say exactly what you mean in plain language. You are like the Oracle at Delphi. I never know what you are trying to say through your anger, disdain and contempt. Are you quoting Dr. Osterholm in support or in opposition to your views? Do you think he is dead wrong? What are you saying? I am not arguing against or for you. I just want to know what you are arguing.

Forgive me revere, just couldn't resist:

See no evil, hear no evil, speak no evil is a common phrase, usually used to describe someone who doesn't want to be involved in a situation or someone turning a willful blind eye to the immorality of an act he is involved in. Sometimes, a fourth component "do no evil" is added to the phrase.

"Michael Osterholm, repeatedly, in his new Foreign Affairs article says, "No one can predict when the next pandemic will occur or how severe it will be."

That is just how scientists say they are not all-knowing and can't see the future; they can't prove it in a peer-review process when it will start or exactly what severity.

Now, if they always added, but, each new human case could be the start of a pandemic year; we don't know it isn't until we see it doesn't explode a few days later, and add they have been preparing their families for months, and remind people our systems are already flat out; our ERs hospitals, staff, law enforcement, National Guards, fuel supply, power grid, JIT distribution systems cannot take any sort of national/global surge at all... remind people what H5N1 seems to be doing now to what age groups and say it is foolish not to prepare against a known threat, given the virus is in mammals and nations we can't ever know what is going on...

... then, they probably wouldn't be allowed to talk at all - "National Security"; if the public listened, and the stock market convulsed early, and public started protesting lack of warnings and lack of preparations; tsk, tsk - can't have that.

Thanks for the analogy to a favorite oracle of mine.

In very simple terms, I iterate:

It is not rational to believe that humans cannot collectively analyze and project future outcomes.

It is not rational to continue to say, "We do not have the intellectual capacity or the technological tools to forecast the evolutionary direction of this virus, H5N1."

Yet that is exactly what has been said for the past 3 years during which I have had an attentive interest in this topic.

Is this clear, to this point?

Setting aside the repetitive belief, almost religious in its intensity and fervor, that we cannot look at the virus and apply current and expanding data and technological/scientific understanding, and you and I end up with the same question. "Is it possible to apply thought to the question of prospective virological evolution?"

Just because nobody in mainstream does this or supports doing this has zero to do with our ability as thinking, rational humans to do so. I assume you agree. We are where we are because the answer to my question is "Yes", not "No".

Osterholm has talked in terms of consequences. Anyone who hears prospective facts can deduce the same consequences. That is not the acrobatic trick needed here.

What is that "trick" that is needed here? (Please do not tell me that it involves following yet again one of the (and yes this is cynically stated) well-known "seer's of virology as the battlefield of H5N1 is littered with their rear-view observations and their "I don't know what's happening's".

IMO, until there is a team of independent thinkers not dominated by you know who who will look at virology proactively and who will apply statistical probability, we will continue to be reactive and nothing more.

IMO, not only will the vax be reactive, late enough onto the stage that the virus will have long past evolved away along its many clade pathways, but given the risk of short time, will be marginally of value to those few who can gain access to the vax of that moment.

There is one simple idea here. I will stop dripping in cynicism as the question at hand happens to be life or death for say 10% of the human population, a topic worthy of at least further exploration. My apologies for my spiteful posturing, but this question is not even close to rocket science, and the myriad of excuses hidden in the "we don't know what's what" political posture is outlandish and continues to block vax funds allocations, and in fact allocations of nearly all public health funds for what, if we had a real probability number, would be or not be allocated.

Delphi (much appreciation for the flattery)

Excerpted from fluwiki re: the immediate need to know the imminence of H5N1 reaching phase's 5 (as I believe that phase 4, as I define it, is now happening in Indonesia and Egypt, albeit infrequently, yet persistently)

>For any of this to happen, leaders of all stripes and at all levels of government and business must privately and publicly acknowledge the imminence and severity of the risk. Without that, I firmly believe that none of the rest will happen, as every step relies for its justification and support on the common understanding that both the imminence and severity of this pandemic risk require us to take these actions and to take them now.<

ITW(Joel J) Into The Woods

Not to undertake an immediate and intensive study regarding "How imminent is H5N1 pandemic phase 6?", with thoughts regarding the answers being posted publicly, as it is the public who are at risk, is imo reckless.

As I have zero faith in the competence of public health officials, be they local or at CDC, to address this extraordinarily challenging question, I expect little to no guidance in this area. And the obvious consequence is a public who will be nearly totally unprepared for pandemic.

Fortunately, it's not on my shoulders as I'm the lay public. But for those who hold office, hold job titles with epidemiology or public health in them, this is imo a pair of albatross.

The list of see nothing, do nothing undertakings in the area of H5N1, where it really counts, not the simpleton observation that catastrophe is catastrophe, at the bleeding edge in the USA is pretty much a good reflection of the state of this nation-state. It's no better in most of the first world. I have continued to hope that that your liberal view of reality would have resulted in a much more strident and indefatigable call for action "now" at each of the leading edge issues. I can't understand why you "see little", mainly react to news, and seem happy with that.

This has been an outstanding forum to reach people whose jobs it is to think proactively, not to count inventories of bandages. I look forward to your pressing the PH community to get their legs in motion and get something done yesterday.

In very plain English:

Nobody wants to do nuthin' that puts their job security and retirement pensions at risk.

I ain't got no employee job. So I can speak my peace. As I see it, if peeps have no number range of probability to work with, they'ze gonna decide that the risk is near zero, just like the risk of nuclear bomb going off in their neighborhood; could happen, but it won't. They see nuthin' on the horizon and therefore, there's nuthin' for them to be concerned about.

I only care because I like the world as it now is, and a lot of very iffy people have placed that world imo at big time jeopardy.

Some interesting math... There is a 16 year old Lao girl in a Thai hospital. So far her treatment has cost 800,000 Baht.=23,000 USD and change. If all things are equal and she is critical right now and likely to go, the Thai government would be bankrupt having spent the enitre 07 budget if they treat 20,000 and change people to a positive or negative end.

They also now post that you only have a 10-20% chance of living if you get it... Official Thai release. Little higher than the WHO has led us to believe. Again, other than palliative care after the onset of H5N1 in anyone that goes symptomatic, its fairly evident that you will not make it. The costs to the worlds governments will be commensurate with their ability to pay for you to basically die and somewhere along the way they will have to cut even that or superinflate an economy post of a pandemic.

Then you get into a situation of too many dollars chasing too few people scenario rather than the too many dollars chasing too few goods. Economics 101. I woud submit that the reason they are not talking it up any longer is that we have been warned, they can do and say anything they want now and that to speak of it is now really taboo because of the effects on the economy leading up to it.

When is an ommission a lie?

http://www.nationmultimedia.com/2007/02/28/national/national_30028085.p…

Revere>GR: Your assumption that we can make a prediction of where and when and how much I consider to be wrong and naive and not borne out by the evidence.<

I did not state any assumption as to where or how much. I stated a simple question, "Is this virus imminently Phase 6?"

Just as it was a failure to depend on reassortment because that's the way it is supposedly elsewhere, and the virus has kicked that one to the side, if the opportunity to determine the probability of this virus is lost because of a haughty claim that it is "wrong" to attempt to determine this probability, is an insult to the capacity of man's brain to think, induce and deduce.

The consequences are well known by every single virologist who has spoken about this in the last month (some who said it will never happen now remain silent...and one wonders why). The WHO says CFR = 60%. What it will be in pandemic is a gamble that no rational person will take; it is what it is. Plus we know there will be significant collateral damage if the CFR is anywhere in the low single to double digit range.

We even have a CAR estimate that is a working number from the CDC 25-45%.

But what prevents most people and institutions from preparing is an estimate of imminence, and the supporting reasons for that conclusion.

Somehow, you think that people respond to "grays". I believe they respond to black and white. I think I know more about this little area as I spent decades as a marketer and have read extensively on what motivates people...not to prepare, but to act. Sandman has his scalpel; I have been trained to swing a meat cleaver to cut a very broad swath and I can tell you probabilities of success based on testing, etc, etc. I'm not the turnip off the truck. You're in PH. I've been in sales for as long as you've been in PH. I think I know what I'm talking about. The game is 'getting to "yes"'. We want them to prep.

Without a probability number and supporting logic, I can tell you that what you have seen will continue, until panic sets in. (Look at the drop in the world's stock markets yesterday; they vividly make my point. Look at sub-prime loans that are failing; they vividly make my point.)

People will seriously and independently consider the risk when they are told "the risk of imminence."

You have mis-stated what I said, sadly. There is no 2% middle road. It is pushing a truck filled with cement up a hill. Either we know or we don't know. If we don't know, it's disingenuous to tell anyone to prep.

GR: Let me state what I think. We should be preparing as if this could happen at any moment even though I don't know whether it will happen at all. I've been prettty clear about that. Preparing for me means strengtheing the public health and social service infrastructre so it can handle whatever comes along and doing it now. Thus it doesn't matter whethe it is imminent or not. It is the right thing to do. I refuse to say it is imminent when I don't know this just to motivate people because I believe that when you lie to them you lose. They will not believe you later when you really need them to.

Regarding CFR, anything over 5% or 10% is irrelevant because it would saturate whatever we can do to prepare for it. 10% is pretty much the same as 20% in that regard and I have no idea which is correct nor does it make a practical difference to me. I have to do the same thing in either case.

Being in sales doesn't prepare you to be in public health, although regrettably some people in PH believe it does. I don't. If you want to do a selling job, talk to a PR person, not a PH person. I'm in the truth business and I'll leave "sales" to those with expertise in that. I just hope they don't ruin the brand.

Preparing to me also means having the public prepare to cope for as long as possible; no way an infrastructure can meet all the populace's needs. "Warn" them at least half as much as an election candidate is "sold" to them.
Don't put a website up and tell communities to have open, "all" stakeholder, committees making local policy and preparations, and then, impose no penalty for states and local officials that have done nothing to meet the needs come pandemic, nor told their public about the pandemicflu.gov website, nor that we're on our own.
(Sure would be a good use to that weekly prez radio address. Throw in stories about the latest cases, -costs!- ages and outcome every week, too.)

MRK: "When is an ommission a lie?"

When is a concerted policy of ommission negligant mass homicide?

Govt said, everyone needs to be getting prepared, public knowledge and participation in preparation, local community planning, ect, is critical, yet they say, for Mitigation, since the public won't have effective antivirals or vaccines, close schools for 12 weeks, but, then tell the public two weeks of supplies is enough. (It is not. Sure, a lot of people will be dead in two weeks, if they didn't aviod contaigion, but that's no reason to have such a low goal.)

I can't say the local health honcho here did much for your "brand" revere.
I also see a lot of websites that have the public trust and that should know better, repeating things like: H5N1 affects birds, (no mention at all of mammal species being affected) -some even still say, H5N1 has never gone human-to-human.
Can't get public interest in funding critical infrastructure, if they don't know they've gambled the past 16 months in a pandemic alert, and, if they don't know that they or their kids might get sick and die that there is no treatment or vaccine that can save them right now; they need to be better prepared to save themselves.

Having a pantry and getting out of debt will also make them stronger in the face of storms, job losses, health setbacks, earthquakes, ect, if they aren't worried pandemic may break out next week. If the public was somewhat worried, they would also see our public health infrastructure, our own food and energy and medical resources production, and, our homes, might be where real "Homeland Security" starts.

Dear Revere,
I don't think you're seeing the issue clearly.

Public response to the prep request has nothing to do with what you think is moral or ethical.

Sales does not mean "lies". It means a clear focus on what the public wants and then delivering one's message so it can pass through the filters that keep crap out. For the public, panflu is crap, and they keep it out. On this point, the facts speak for themselves.

"Sales" here means taking off the academic mortarboard and as Quato said in Total Recall, it means "open your eyes". In this case, it is smack in the face simple. The public wants to know whether or not pandemic is imminent or will shortly be imminent. That's all they want to know.

When you tell them pandemic is imminent in one year because these are the reasons: a, b, c through x y z, with charts and with historical proof (citing 1918 blah, blah, etc), the public will hear the conclusion and they will immediately question the conclusion because the public is suspicious of anyting demanding a "change". Go down to the ghetto and ask about the phrase "going through changes". It might be eye opening.

The public wants to know. The public wants reasons that support what is said.

They hate the government saying, "PREPARE" TO DIE. PREPARE TO GO TO HELL. PREPARE SHEMPARE. WHOPARE. It's all gobbledygook, and it's offputting. Of course, it's ethical, and it's right and it's rational. So what! We're talking about the public.

And that's where "sales" comes in. In this case, "sales" is common sense.

Your opinion that you don't know, that it can't be done, that that that...is just that...your own opinion, a self identified PH opinion no less.

What counts is "what the public wants!!!" They want to know if this is imminent. So, organize your best and brightest and across a broad spectrum, from Webster to Niman, from backward looking to the most avant garde thinkers, including historians, and create a construct of options. Then TELL THE PUBLIC.

I promise to give up chocolate if a responsible, sincere effort is undertaken to analyze the question of imminence and then to publish and announce the reasons for that conclusion. Whoever does it will become the lightening rod to the pandemic prep "industry". Do it yourself. Be the Paul Revere you like to consider yourself. Do society a good deed.

Thanks in advance.

GR: The public may want to know, but I can't tell them. They want to know who will be the next President, too. But I don't know. I know it will likely be amongst a small group of people and it won't be you or me, so I do know something. Just not what they want to know. I can't analyze imminence because I don't have the tools. I don't think anyone does. I am not a believer that the signals are in the sequences. We don't know enough about the relation of the biology to the genetics to use that tool. Others, obviously, disagree. That's fine. Let them warn everyone if they think thy know. But I have to be honest with my opinions.

Regarding the Revere epithet, it isn't a reference to his warning function. It is a reference to his serving as one of the first members of the Boston Board of Health, the first such in the country. And that is where my focus is: strengthening public health infrastructure. I am not interested, personally or professinally, in individual prepping. I am not against it. I just don't have an interest in it.

It is such that you have to prepare now;
if you wait until you see for sure it is occurring, it is too late to prepare.
Just like the Mt.St.Helens erruption, the tsunami wave, the Katrina hit on NOLA, (or, any car accident; when you're sure you're in danger it's too late to buckle your seat belt, invent airbags, and by then govt won't sell you car or health insurance; too late).

Too late to start building an ark after 40 days of rain,
too late to stock up years of food after it looks like it might really be a seven-year famine...
Preparation takes a long time; too early we can live with - too late and we'll die.

crfullmoon; I am not prepping personally. I have said that many times. I am working as hard as I can to see that the community is ready. And personally, I do not agree with you. I think you are incorrect. There are a lot of things to be concerned about in this world and a pandemic is one of them, but only one. Our country continues to ready itself for another war. There are other health threats. You concentate on one. By all means get ready for it. Realize, though, that others have weighed things and priorities differently.

People who feel a need to argue with Revere, more exactly, people who feel a need to make Revere endorse some other policy, should read very carefully what he has written in the few comments above.

Revere, you have my respect

I can't tell you, how much I (and I'm sure MANY others) appreciate your honestly. We look to experts, like yourself, to help us interpret what we are seeing. We MUST (and I mean MUST)have people who understand tell us things as they exist today, rather than "selling us" something.

Please don't sell yourself out for the cause.

I admire your ambition to help fix the health care system. It's a noble cause for pandemic preparation, but for the general good as well.

I understand you don't need my blessing, but your posts here are well done!

Revere,

Alas, someone in medicine has come to the rescue, a Revere.
Under the auspices of the U of Iowa, a betting pool is forming, with participants, who are the willing, to be comprised of "epidemiologists, veterinarians and other medical experts worldwide".

Should you know someone who you respect and who cares about this topic, the contact person is "Dr. Phil Polgreen, a University of Iowa assistant professor of medicine".

As of this time, the probability is 43% chance that pandemic threatening humans will occur this summer, should that be of interest to you.

You may find the posting here:
http://www.tucsoncitizen.com/daily/nationworld/43402.php

As you see, the question I've posed is well beyond that of a mere sales guy; should society survive a pandemic, then there will once again be an opportunity to convene a board of health. Until then, please continue to drain resources for plans and programs which could not and would not function should 60% CFR and CDC rule of thumb 35% CAR come to pass. Please... as I must return to peddling my line... reality

Not saying that PH can't figure it out on its own, the UofIowa website says this about predictions re: panflu -- (Given they intend to include only members of ProMed, does this not doom the project to low probability bias? ProMed's track record on this topic has been most of the time very "off", albeit traceable to a few "mod's". Perhaps a wider audience would be less likely to conclude "not happening, not here" as ProMed was wont to do so often in the past when commenting on the reports passing through?

UofIowa> An avian influenza prediction market will not replace existing influenza surveillance systems nor will it eliminate the need for improvements to the existing systems. Instead, we propose this prediction market as a supplement that can quickly aggregate expert opinions based on existing surveillance information. Prediction markets have been shown to be especially effective at quantifying subjective data. The probabilities generated by this market could help policymakers and public health officials coordinate resources, facilitate vaccine production, increase stockpiles of antiviral medications, and plan for allocation of personnel and resources. [snip]
>The goal of this research project is to provide more accurate estimates for the likelihood of certain events -- by date and location -- than are currently available.

>There is nothing extraordinary about prediction markets. As an alternative method for gathering and processing information about disease occurrence, pathogenicity, and progression, however, they are novel and hold much promise.. A successful avian prediction market will include epidemiologists, clinical microbiologists, clinicians, virologists, and veterinarians. The Program for Monitoring Emerging Diseases (ProMed) is the largest assembly of individuals concerned with monitoring and tracking emerging infections diseases. We will recruit exclusively from within ProMeds membership. To join ProMed, go to www.promedmail.org.<

GR - Either you, or me, misunderstood the question, in the betting pool. Here is a quote, from the article:

"They would buy contracts based on odds that deadly bird flu will infect a human in Hong Kong by July 1.
"Yes" contracts are trading at 43 cents. Experts think there's a 43 percent chance of that occurring."

I saw a similar article, from another source, say that contracts for H5N1 infecting a US citizen before July 1 were 5 cents (or 5% odds).

Perhaps I've misunderstood, but I don't think the chance of a Human pandemic before July 1st is trading at 43 cents...I think that was just someone in HK becoming infected.

Revere: "There are a lot of things to be concerned about in this world and a pandemic is one of them,"
By trying to be more prepared for such a huge one, public and communities would be more prepared for many other things. The public needs to take more responsibility for what is going on around them.

"others have weighed things and priorities differently" Yes; we are not all as old, as financially and as "who you know" secure, different locations, different responsibilities, many differences.
I don't think I don't need to prepare, nor want to trust things will turn out fine, just because you or other figures say you have taken no extra steps.
The govt never said a truer word than when they said, don't plan on fed or state govt to be able to save you from a pandemic year (well, I wish they'd say "year" out loud) and I know my local govt is taking no effective action.

Since others like Dr.Osterholm, Dr.Nabarro, Dr.Webster feel free to travel I can't judge my travel likewise (though Guarida Ray and others certainly can choose their own risk/benefits) the Drs. may feel it is their duty to try and travel and talk to people, up until they get stuck in pandemic somewhere (haven't some of them made safer provision for their wives and young children that they themselves plan to use?). Some may want to do all they can on many fronts pre- but, have no personal wish to survive a pandemic or after; who knows?

"Until then, please continue to drain resources for plans and programs which could not and would not function should 60% CFR and CDC rule of thumb 35% CAR come to pass."

That is how I and perhaps more of the public, if they actually knew what was going on and that all these things were possible; they just aren't hearing about them, see a system that does not want to share power -not even information- and I do not think it can even become robust enough to handle panflu paternalistically from the top down, as if citizens (who far outnumber the military, bureaucrats, and public health, and hcw, and responders, and essential workers) are not legal adults; the public has to be personally part of the pre-pandemic preparations, if real mitigation of suffering, death, and long-term societal/economic damage is desired.

crfullmoon and others here: We agree that preparing for a pandemic also prepares us for many other things. I think we disagree on several other things, however. First, my idea for preparing for a pandemic emphasizes community resilience, especially public health and social service infrastructure. I advocate strengthening maternal and child health services, vital records, substance abuse programs, etc., all as part of pandemic preparedness. I don't get that from what you say. Moreover I am not particularly interested (personally) in individual prepping as I don't think it is such a community benefit, although it will help the individuals who do it (maybe). I'm not saying don't do it. I'm just saying I'm not interested.

In addition, I think we have a difference in how we regard the community. I detect in many commenters here the notion that the "public" is blind and ignorant and if they knew Truth as you knew it they'd get on the stick. I don't see it that way. People have a lot of things to worry about, including whether they will have a job, paying the mortgage, whether their kids are sick or many other things. It is hard to get their attention for smething that especially bothers you. They probably would like you to spend more time getting decent health insurance for them. I don't presume I know what people should or shouldn't do. I can tell them what I advise from my point of view as a public health scientist regarding things I know about.

And that's what I try to do here. I certainly have opinions and a point of view and I make recommendations I think make sense. But I that's the best I can do. I don't have a monopoly on wisdom nor am I standing in their shoes. Climate change is probably a bigger threat to the global population than a pandemic, or at least many knowledgeable people I know think so. They probably think you are wrong to be chasing this short term threat when there is a bigger long term one. One of my close friends, who is one of the world's pre-eminent infectious disease experts, thinks XDR TB is a bigger problem than bird flu. He has seen most of his patients die of AIDS in the last 25 years. He knows more about both diseases than you or I do.

So by all means keep advocating for what you think is right. But remember that others may have different views, and it's not because they are ignorant or don't know the facts or don't get it. From their point of view, you are the one that doesn't get it.

"getting decent health insurance"

Single-payer/govt maybe; health insurance vulture-layer; no. I don't want a health insurance "policy"; I want basic and preventative health care for all.

strengthening maternal and child health services, vital records, substance abuse programs, etc., all as part of pandemic preparedness Sure; needs to be done, but, unless you say it is part of panflu preparedness, and get households caring, it won't be enough.
There is no way we have time/money/science enough to get public health robust enough to ever stand between the public and a pandemic like H5N1 (or any combo with the flu strains since 2003).
Even if one profession's disease project got solved, all their work will die in a panflu year; HIV, TB, drug abuse, global warning (what if so many people die off we don't even know how to safely shut down the nuke plants, handle toxic waste, all the other bio-hazard incidents waiting to happen, if we have high, prolonged worker absenteeism, supply chains broken, let alone add high fatality rate from lack of effective care or viral nature?) school fundraisers, but, don't tell families panflu could start this year?
De-globalize our food chains; get back to local, regional food production, and increase actual food inspection, by agencies that aren't tied to food export success. Skip the global junk food industry.
Make sure every nation can make at least half of their own needed meds; perhaps places can specialize and trade off, but, no place should lack capacity.

I consider changing over to regional, sustainable fuel sources, and increasing conservation of resources as needed for both panflu, and, to stop wrecking our ecosytem.

I don't think tourism and business air travel can continue at present levels, for mulitiple reasons, the "globalization" of manufacturing has not brought "progress" to US jobs, "developing" countries' worker nor environmental health (Our and others' corrupt govts fault for not taking best practice environmental and worker laws and enforcement and "globalizing those.)

Also, anyone travelling needs to be more health-literate, and more careful of infection control, so do the places they visit. XDR TB is one of many reasons why this is vital.
There are many illegal activities going on globally that need to be ended totally, that would also lessen diseases gaining new ground.
(Diseases the doc on your block, or the border guard, isn't even thinking about nor able to identify, but can turn up at any time.)
Violence against women, inequality, and maternal and child health have to be improved everywhere; why not also warn them about pandemic and other diseases, and educate them in basic science, health and farm/food safety?

We could pair communities up worldwide, and help them make better public health infrastructures; we have nothing better to do than watch tv shows, gamble, and buy more than we need?
If the public is bored, they could be "sold" better things to do, in their own communities, and to help a paired community, in sustainable ways, if the few top people in corporations and politics didn't like keping thing$ they way they are now.

People have a lot of things to worry about, including whether they will have a job, paying the mortgage, whether their kids are sick or many other things. It is hard to get their attention

I disagree; it is easy to get their attention; they just need the messages to stop being mixed to "prevent panic" (:any unordered change in consumer attention, spending habits, or blind trust in the govt?)
Pandemic would make a big impact if whether or not they and their family got sick, currently it looks as if getting sick will mean you will die, especially under pandemic conditions. They care about risks like that. The govt has said, expect no aid. To some this is a new idea and needs to be pointed out a pandemic like 1889 or 1918 is a deal-breaker.
Panflu would affect whether they had a job to go to, could get to it, if it could pay them, if they could pay their mortgage, and they'd demand answers the govt doesn't want to work on, or disclose. Do banks want to foreclose on mortgages if we have a depopulating event? What good will it do them? Does the govt want to throw everyone in jail if they can't pay their taxes; how could they do that? If we have a state of emergency for a panflu year we need to bail the citizens out afterwards for a change, not the corporations and their CEOs.
The public is why there is an govt and why we have a economy. Encourage them to be frugal (they can still have fun) and get out of debt; have savings for a rainy few months, not just a day.

Back in the early 1980's, I wanted the govt to educate the public about HIV; say that everyone with blood was at risk, and educate everyone how not to get it; we could have had a society that supported these goals.
"Leadership" foolishly chose otherwise; they still fight it.
Sorry about the long post.
(MRK can also see I have more stupid ideals than bullets, oops.)

Revere>my idea for preparing for a pandemic emphasizes community resilience, especially public health and social service infrastructure.<

When you need your agenda advanced, you will fall on your knees and talk to "sales" people called lobbyists and activists.

Until then, your efforts and those in PH are quixotic. He who has the "ergs of power" rules the roost.

I'm not immodest about being able to lobby a position. I'm concerned that what I would be advocating be based on what I perceive to be fact, and has an outcome that is not sold for money but matches your intention as well, the good of the people.

You've raised additional very real issues which will impact on all of us, as well: global warming, XDR TB. With a massive die off, the global warming issue will have been in large part addressed. The other will also diminish as the deaths in impoverished countries will effectively quarantine the currently unquarantineable. If someone's sick, they'll be off the life stage very quickly from a Phase 6 60%+CFR HPAI pandemic.

As I said, when you need someone to "hear of evil", think about retracting your position re: "sales". Til then, PH continues to remain a scullery maid on the world's political stage, which I don't like yet I will acknowledge.

The call is to prep, yet you think it of no personal value. Why ask anyone to reinforce an institution when the people who make it up will be totally exposed to pandemic? That is the height of folly, is it not? This diametric opposition is dramatic. For the public to do other than as you ask, and for anyone within PH to do anything that you ask to enhance PH institutions would be a waste of time as the beneficiaries and the participants will be fully exposed to Panflu CFR's so high that when exposed, they're in essence all dead. We'll all die. Some desire not to do so prematurely. I fall on that side of the ledger. Maybe I should move over to your side instead?

CRF-Nice ideals to have in life. I have just seen way too many things that would change that view. I personally dont think that this stuff thats running around is anything more than natures housecleaning. Too damned many people. E.g. if it is global warming induced by humans, then the Earth is responding in the only way it knows how. Trapped viruses in ice and frozen tundra, new and exciting flu's, XDR everything.

To top it off it seems that in the face of the coming Tsunami of Something, everyone wants to go down to the beach. Some to study it, some to watch, some to surf their last big ride. But go they do. Lemmings.....

GR: I'm not trying to convince anyone to act like me. If my personal safety were uppermost in myh mind regarding panflu, I'd be prepping, but then I'd also not consider tending to anyhone who was sick either, if that were number one for me. Maybe when the time comes I'll turn tail and run and wish I had a pile of Tamiflu and 3 months of water. Then I'll be sorry. But right now I'm thinking about other things, and since my profession for 40 years has been public health I think in terms of populations and communities. It's what I do.

I do plenty of "sales" in your sense, having testified in front of Senate committees on a number of occasions, at our state legislature and twisted the arm of various US Senators and Reps over various issues. But when I do it I have my professional hat on and I stick to things as I see them. I don't embellish and I try not to over reach. That's how I've managed to retain my credibility, which I hope is reasonably good.

I'm not objecting to other people doing it their way. I just have to do it mine.

Revere, what you are saying makes sense! Finally, I'm able to identify with this thing more. Until recently, every time I came here, I felt like a moderate republican at a gay pride march! :-)

I mean, I'm a little worried, but when I try to find news or information from bulletin boards or blogs, I find myself in the midst of panic and doom. I felt very out of place. But your posts, especially as of late, are proving why I find so much value in Effect Measure. Well said!

Again, you don't need my support, but I admire your philosophy and your determination to not sell out. Please continue to "tell us like it is".

And by the way...your concern for the general public and population in general, is welcome relief from the individualistic approach of SIP type prepping. Like you, I'm not against it..and do encourage people to be ready for emergencies (I'm trying, on a small scale myself). But I like to think my community contains lots of people like you! It seems to me, your approach will be the only way to minimize suffering, should a severe pandemic come to pass.

"your approach will be the only way to minimize suffering, should a severe pandemic come to pass." ?

Not if it starts next week it won't.

Why can't both; what revere wants to happen and household education and preparation to avoid infection and cope, and have made preparations to keep the power plants, ect, up,
if case this has a high attack rate and may continue to be fatal? The medical system won't hold up a fortnight.
We need better mass fatality preparations, including telling the public losses from all causes will increase during a panflu year.

What would your local and state and federal officials be doing (if anything useful) if we are now in Phase 5 (in all but announcement)?
What will the public wish they had done differently if they wake up in a 1km quarantine zone (and/or) the beginning of a panflu year?
The feds put that website up Oct. 2005,
Leavitt spent money and went to all 50 states and had summits,
saying, household and local preparedness is critical,
but no one in fed/state/local politics nor holding a taxpayer-funded job wants the public to actually read the website and, understand we're in a pandemic alert, and do what it says?
For shame.

CR - Do you have enough money, should your house burn down to build a new one? Have you saved enough? How many people do? How many people would take the risk of a home fire seriously enough to SAVE that much money.

Or, do you have insurance? Insurance is spreading the risk among a much larger population and it's the only way to properly mitigate the financial risk of losing your home to fire.

Similarly, we need to spread the problems of H5N1 among the entire population. There is no way, individually, we can each prepare properly. We can do some things, but individually, we can do little for the common good on our own. We can't store enough food for everyone, we can barely cover all our own bases. The task is so overwhelming, that many people find the task to insurmountable to start.

I'm guessing, that is why Revere is working more toward the population in general, verses individual prepping. I know that is how I feel and why I think his idea is a better one.

Again, preparing individually, to some extent makes good sense. I have no problem with people having enough food and water on hand, for a short period. But we need to prepare at the community level. That appears to be what Revere is advocating in Health Care, which is his/her particular niche. I admire that!

"But we need to prepare at the community level."

Can't do that, our communities have no clue pandemic is really hanging over their heads; second year in a row after the MA panflu summit that nothing will be said in our town meeting/annual budget about changing our priorities to prepare for a pandemic.
The time and money spent on all those pandemicflu.gov checklists for individuals, schools, community organizations, faith groups; they aren't being read, discussed, nor acted on. 17 months on, and the "First task" for state/locals has been deliberately avoided: " Establish a Pandemic Preparedness Coordinating Committee that represents all relevant stakeholders in the jurisdiction (including governmental, public health, healthcare, emergency response, agriculture, education, business, communication, community based, and faith-based sectors, as well as private citizens) and that is accountable for articulating strategic priorities and overseeing the development and execution of the jurisdiction's operational pandemic plan."

What happens after your "short period"? A pandemic and it's knock-on effects are not a "short period" event.

Revere: "my idea for preparing for a pandemic emphasizes community resilience, especially public health and social service infrastructure. I advocate strengthening maternal and child health services, vital records, substance abuse programs, "

Revere's idea has said nothing about municipalities stockpiling food, nor imported meds, imported spare parts, having communities publically discussing how they will meet their own needs- a few public health people are certainly not going to, with no antivirals, no vaccines, nor real medical care for the general public. Didn't buy biohazard PPE for the "volunteers" and hcw and responders, either, and I don't think anyone should be forced to risk their lives without it.

I have no debt; I do without some things many people spend money on each week. I also know no official agency is getting ready to meet the needs of its citizens homebound by illness or quarantine for the duration of pandemic. They are not preparing for the likely high fatalities, not in a way the public will find acceptable, anyway.

"The task is so overwhelming, that many people find the task to insurmountable to start."
The only people who know how bad it might be, and have decided to hide that information from the public, and who have seemed too overwhelmed to start are my local and state officials that know about the pandemic alert. They only want to be ready to tell people what to do after we are under a state of emergency; count the sick and dead and wait for vaccines. They are too afraid to tell the public.

"There is nothing we can do; we have no vaccines, so we can't tell the public to look at the govt website" -local health honcho in charge of pandemic "planning" and "informing" all my other municipal "leaders", Oct. 2005. "If it's going to be bad there's nothing the public can do anyway." (Untrue, and we never said he gets to play god.) He has misinformed the local officials, so they will not tell the public anything in time for proactive preparations, either.
"All-hazards" covers all except a deadly panflu year;
by failing to prepare the public, they are preparing to fail the public.

If there's a shortage of food, water, normal medications and even N95's/N100's, latex gloves, and easily available goggles, this desire of Revere's is as I said tomfoolery.

crfullmoon hits the PR people on the head and says wake up to the immediacy of the needs to survive. Without those, there will be nothing that Revere asserts to be important, > my idea for preparing for a pandemic emphasizes community resilience, especially public health and social service infrastructure. I advocate strengthening maternal and child health services, vital records, substance abuse programs, etc., all as part of pandemic preparedness.<

If you've read Johnathan Swift's Gulliver's Travels, you clearly remember the academics who were heads on platters floating around, zipping hither and thither. He termed that "land", "La Puta" (easy translation, a land populated by "whores"). I think that a re-read of that chapter will help re-establish some perspective amongst the more erudite among this readership. Swift saw it then. Are we seeing it now?

The bottomline is that if Revere thinks he can float above the fray, insulated from the virus, well if Revere thinks that, then what's there to say. If not me, then who? If not now, then when? (paraphrasing Hebraic thought).

If Revere's decommissioned, the entire suite of "plans" are lost as is the visionary who drives them forward.

Its one thing to be religious and sacrifice ones life. It's another to a LaPuta resident. Set your ethics apart and decide if there's a real risk here from H5N1 or not. If you can't, then tell us all to go back to sleep because this is yet another monthly safety lecture. Yawn.

@ crfullmoon & GaudiaRay

Why do you continue so relentlessly to insult the Reveres? They are well aware of the problems. One of them was treating victims of the Chicago Police Riots at DNC68.

The Reveres are at least trying to do something useful. All you have done is criticize their efforts and declaim the dismal conditions of your own communities. You will have no credibility until you can report some results at home.

Gaudia,

Since you are so much smarter than the reveres and the rest of us, why don't you get your own blog so that you can tell people "the truth" as you see it. It isn't the revere's job to trumpet your theories.

GR - You said:

"What happens after your "short period"? A pandemic and it's knock-on effects are not a "short period" event."

How do you know that? Or what is your definition of "short period"? Because I disagree. In 1918, according to local newspaper accounts, the height of the infection appeared to last 3 weeks. That's not the entire duration mind you, but the worst of it lasted roughly 3 weeks. It appears that most cases appeared within a 6 week time frame.

I was reading accounts from a small town. But standing together is always a better option than going it alone. Pulling together for 3-6 weeks is possible, if the Revere's are able to accomplish their goals. And THAT will help far more people in total than individually prepping. Simply because few people will prep on their own.

Patch, as to duration, it's like this: when we think it's going to rain, we ask ourselves if it's serious or just a drizzle. If just a drizzle, we don't even bother with an umbrella. At CFR 60%, we need a tent, not an umbrella. At a CFR 2% +, while you think and CDC thinks we need an umbrella, it is human nature to be lazy and to be positive in our view towards risk outcome.

The CDC has been a bit too clever here. Their logic is that at CFR 2% they can pull the trigger early...school closings, etc. What they've failed to do is to talk to a marketing firm. They missed the fact that people will do nothing in a misperceived response to a notice that the risk is "mild". I'm positive this is exactly what they're facing and will face interminably. We despise bad news. We avoid risk. And we will avoid prepping irrespective of what carrots or PSA's or dog & pony shows are launched, or talking heads on TV are trotted out. It ain't gonna work. They failed to talk to marketing experts. If they want a list, they can ask me. If they want to beg the Ad Council, they should look at the percentage of the Ad Council's PSA's that failed, and then step back and talk to the award winners at the DMA and the LDMA and the HKDMA. At least get input from people who know what to do. Instead, it's an attempt that will fail. I wouldn't care, but there's a level of discomfort that the virus can turn phase 6 earlier than before they can get the kinks ironed out, on their umpteenth try.

Greg, I consider the Reveres to be the pre-eminent leaders in the area of pandemic alert. They have been outstanding guides into this esoteric topic. They continue to shine bright lights on the roadblocks and misjudgments. I have high praise for their indefatigable efforts. I am one of their longer-present "students"; Melanie thinks me failing the class. As with any teacher, in the much-modified Socratic method, they are not immune to challenge or to explorative debate. And for that I'm very appreciative as well.

GaudiaRay, you have failed to challenge or to debate. You have merely insisted over and over that they do what they patiently explain cannot be done.

They are, by the way, "pre-eminent leaders" in public health not "pandemic alert". You have not learned what area of expertise they claim, let alone enough to challenge.. or even ask a proper question.

Greg, I don't think I was insulting the reveres, just disagreeing with them.

The reason we have no success where we live is because people in positions of public trust, that our elected and unelected officials defer to, have misled or outright lied to them about the need to keep the public unaware; pandemic being a low-risk, short-term, survivable event, public "panic" "would cause worse outcomes than an H5N1 pandemic" would. Who is my town official going to listen to? His peer down the hall, "it is his field of expertise" they "have plans" they're been "working on this issue with the state", or me; just some citizen off the street, who says things he's never heard of via msm? Any notices from the feds or state probably go through this health gatekeeper; not to my selectmen. None of my state or local elected officials knew about nor attended our state panflu summit 2 years ago, and it has never been mentioned at town meeting; that it is municipal and household responsibility to prepare for this.

My local "health" official has tried to get volunteers to blindly sign up "for emergencies" by saying they should be first to get vaccines and that "bird flu" pandemic vaccines will not "take as long as Leavitt said", he went on and on about what happens in other emergencies, pushpacks, and that the town is allowed to call on the SNS (as if there's anything there to meet the needs of our unprepped tens of thousands of residents) and that we have "mutual aid" agreements with other towns.
He also claimed pandemic flu would "ramp up overseas for months" and we'd have time to prepare. Not what MIDAS simulations showed, right?
The one presentation he gave to the public (when most everyone had left town, for vacation) was so skewed that an elderly gentleman raised his hand and asked, so you are telling us 72 hours after pandemic is declared, we will be in this building, vaccinating the townsfolk or handing out antivirals?? (No.)

No one; Town manager, school district, (and whatever non-pandemic name the group having closed-door pandemic planning is going by), will listen to me, because they trust, defer, and do not go over his head and fact-check, what the person "in charge" is telling them. Not their job, off their radar; he says he'll let the public know what to do once pandemic starts.
Or, we have some (in many sectors) who quite seriously say, "It's going to be so bad there's nothing anyone can do anyway; best not to tell the public." (The health guy said that, in his office; between "maybe it won't even happen at all; hope it doesn't happen"; he needs pre-pandemic mental health care, or perhaps an ethics refresher, after he refused to tell the public what the pandemicflu.gov website says.

"Can't tell the public to prep for more than two weeks because they can't afford it". Untrue and unhelpful. This is not what the taxpayers think they are paying taxes for; they are not preparing because they are getting concerted efforts to keep them calm and from asking tough questions about how everything is going to be handled during a prolonged state of emergency.
We can't get traction at home because people trust that if the scientists had said, please, that was an unprecedented earthquake; we can't pinpoint where and when but please put out a public tsunami alert, they trust their govt would pass the alert along and tell them to get their kids off the beach and head for high ground, just in case. Once we can see the wave "for sure", is too late for preparation.
They think "it can't happen here" because no one in authority wants to tell them "it could, in fact it could at any time, and govts can't stop it, and govts can't help everyone, so we're supposed to be getting ready".

Start with the people in your neighbourhood, the people that you meet each day.

Infection on Java is now so ho-hum there's no sense of urgency even though it appears to me that there are now an average of 3 people a day who, infected with symptoms that match those of H5N1, are hospitalized.

It's a hear no evil; expect no evil outcome.

Even if the cases are often presenting as siblings, there's just nothing done by epidemiologists there (the locals that is) to prove or disprove bimodality.

Given there is no rational, logical "look" by the Indonesian government at H5N1 (other than responses like "kill all the poultry within the Jakarta city limits, and "call out the troops" as if the troops have some special talents or training), the outcome will be...gosh I don't know what as I don't have tools to understand what's happening over there.

But I can count. And I count 3 people a day who are being infected with H5N1 in Indonesia at this time.

What's the next move going to be? "Check" by the AI side?

GR: You can count but you don't know what you are counting. You are free to assume whatever you want about hospitalized cases of pneumonia on an island that has a half million pneumonias a year in the pediatric population. That's why you aren't an epidemiologist. That doesn't mean you are wrong. It just means no one can judge if you are right or wrong. Sort of like religion. Not like science.

Been there, done that Greg. Ain't going so well; unofficial messenger an all. Putting myself at risk for nothing, because until people here start dropping, I am getting shunned. People trust their govts too much, and hope bad news, like, pandemic expected, no fed state nor mutual help, no vaxes, ect, isn't true;
they're waiting for their "leaders" to tell them
it's an issue we were supposed to be preparing for.
"Leaders" ain't gonna do it.

Revere, not only can I count, but I can think and I've been "there"; spent 3 weeks on Java and Sulawesi, in the the cities and the countryside. If this were not a bird-related event, the people who are living in urban slums and squatters all along industrial areas would be getting sick. One can often drive out of an industrial plant and down the street for a few hundreds of feet and find a "village" right there, with the chickens and the kids and grandparents and nonexistent sanitation, and, and. You can walk out of the Boomi Hyatt in Surabaya, one city block and be in a maze of slum housing, with 2 room homes, filled with grandparents, parents, kids... but there, no chickens, few dogs and few cats. That's why they have caged birds...They're all villagers at heart and within the past generation.

To digress, the city kids in Jakarta and Surabaya, cities of of 10 million, 2 million should be getting sick with pneumonia as well. Not happening often. It's a countryside disease, still. My religion tells me to speak the truth. So far, it's efficient B2H and there are repeated small H/H clusters, some of which are probably H2H. The virus is expanding its infectivity. It has not reached phase 6 or phase 5. If the WHO definition is right, there are good reasons to call this the first signs of phase 4. But the epidemiologists there are not tracking and tracing or looking at bimodality. So, it's really nothing.

Patch-I agree that Revere is trying to get the community to prepare. On the other hand after handing out stuff for two weeks it finally dawned on people that it was a no shit problem whether it was SARS, Panflu or in my particular situation, a quake on top of one or the other. But while he is barking no one is listening. They keep moving behind the scenes in goverment and even today the UK is posting up a story about their little exercise last month.... It was a shambles and they determined that they are going to have to buy plow land to plow them under. Uh, for a 5% even they need plowland? Sounds to me like they are seeing whats really going to happen if it burns into us. If its of short duration as postured then good. It will come in, do its dirty and leave. On the other hand and many are wondering, what if it comes in and stays? There is a lot of posturing that H1N1 rolled around from China to France inside of 5 years but didnt just go out and flat rock against the head a huge number of people as it did in 1918. It could come in as wave 1, simmer and then come back as a newly improved virus six months later.

If that happens, forget vaccines and the only thing you will have is preparedness and that means individually. I place ZERO faith in the system to take care of the US citizenry for a number of reasons and most related to the people in place. Dems/Republicans, people in charge that are not the best in the biz. It will be a media hype first, then the real news will start to be reported, finally after it passes the finger pointing will start. They will say (insert presidents name here) didnt do enough, that (insert governors name here ) overreacted when he ordered the NG to shoot looters. They will turn it into a racial issue, they will turn it into a social class issue by saying (Insert area here) didnt get any vaccine and it was racially motivated. They will turn around and continously drone that they did as best they could with what they had.

Numbers from GR? 3 per week. The fact that its there makes him right about BF. I guarantee thats considered to be an epidemic by all standards. HPAI ? If that gets out and runs you get to apologize and brag... and Revere will still be right. He bases everything he does in the science. He cant pop off and say its coming, but like us all we have a bad feeling about this.

Honestly though Patch you seem to be more concerned in the posts that someone believes that the numbers dont lie kind of thing and that they are wrong because the science doesnt totally back it up. Great... If it comes you can say well the percentages were off by "x" and get the right to say it. I guarantee you that regardless of what you think an Indon who has it and is now one of those numbers, he/she are pretty much guaranteed to leave in a bag. Its like a combat situation, do you care about how many got killed or more who got killed? Its a shitty way to die, none of the governments are moving too terribly fast about preparedness even when the vaccine situation sucks at best.

Talk numbers, talk vaccines, talk about whatever. If you are not personally prepared and this comes at anything approaching or past 8% then you will likely die and probably not from BF. Take that from the response end of the fence.

Must be another counting error on my part.
That really cold weather in the Egyptian Nile Delta has just yesterday resulted in 17 new pneumonia cases.

I count what I see. I don't count what statistics tell me. That is what led us into the mess we are in now. The WHO and its advisors kept saying "reassortment" and don't look at the present, but look back in the rear view mirror.

Pretend that the rear view mirror is broken. Look at the hard questions. Look at today. Explain today without saying "dengue" and "pneumonia".

Or is it pneumonia in Indonesia and dengue in Egypt?

The ugly news is that Niman and thus NAMRU-3 have sequences (whatever they are...WHO doesn't need them, that's for sure) that will show the N294S Tamiflu Terminator polymorphism is to be found in the birds, and that means pro-genic flight back into Europe and Eastern Europe. The Dutch got the picture. They just ordered their poultry indoors. The UK is not able to comprehend sequences, so they just flashed the all-clear.

What I recognize now is that you will not speculate without facts. OK. That's fine. So, why are you commenting? Because it's fun? A drive to the truth, just like when the engineers built the first rockets, involves speculation. Be an engineer. Please build a speculative position and let's see what you really think, not what can be said about the rear view mirror facts.

GR: I've told you what I really think. You just don't believe me. I also have a lot of experience with disease reports. Most of the time they are inaccurate. You just report what you see, you say. The trick is knowing what you are looking at.

Revere, a simple side bet, as a place holder. Today there are 17 people in Egypt with symptoms. People at Fluwiki and Pandemic Flu Information and Flu Trackers are reading the local press there, translating and posting their findings. There is a news clampdown in Egypt, with officials saying the info about bird flu needs to go through their offices, unlike in Indonesia. Nobody is reading disease reports. The news gleaners are looking at hospital admissions and news notices.

Let's see how many of these people have H5N1. NAMRU-3's there. We'll get honest answers. If it's even 3 people in a day, is this just a momentary passing overhead of a flock of migratory birds?

I "hear evil"; you hear noise. This little acid test will bring about some level of resolution for me. I hope you're right. The weather there is 68F in the day and 48F at night, not exactly snow weather, but a bit chilly. Maybe because they don't wear shoes in the villages, but instead just wear flipflops, they're getting sick. That's a real possibility.

GR: I don't bet on things like this. I will tell you my opinion on this matter. In my view, the odds are that there are not 3 people a day with H5N1 in Egypt at this moment. If there were I would be very concerned but I don't rule it out. At this point I'd say it isn't. This isn't a contest or a game. If it is H5N1 we'll know soon enough and we'll have to act accordingly. Please stop pestering me about this. If you guessed right, you guessed right and I guessed wrong. If I guessed right, it doesn't matter in the least to me personally. I don't hear noise. I don't know what I hear. If I could distinguish noise from signal then it would be different, but I can't. And I don't think you can either.

Now let's let this go and wait to see what happens.

Now let's let this go and wait to see what happens.
Posted by: revere | March 5, 2007 05:40 PM

SO SAY WE ALL !!!!!!!

crfullmoon, you do have a problem. Nobody in authority will act. Like most of us, you have no neighbours, only not-quite-strangers who live nearby. You must investigate alternate response plans.

You can, of course, simply complain until there is no time left. Otherwise you might examine how feasible it is to 'go it alone' and what you would need to do to maximize your chances. Perhaps a little village in the backend of nowhere.

I think, whatever you choose to do, you should continue to gently sound people out. Revere is right that only communities can survive; I disagree about how much of our political community need be included.

I think also you should agitate the traditional political bureaucracy to provide resources for public health. So little infrastructure remains that even modest improvements can have great influence on the outcome a pandemic or any crisis. Quite often, if two or three get together and make gentle nuisance, they will give you enough money to keep you busy. Take it and use it wisely.

Greg, I don't simply complain, I just only have e-people to discuss this topic with, nowadays.

Perhaps the very few who were prepping a little on their own just from what they heard in the msm (but had no idea what is going on internationally) will be in a better place to risk agitating together now; I don't know. I feel the time is getting too short to relocate (but, I've been so far ahead of the curve this whole time; let's hope my alarm clock is fast) so, I'm looking into that, and I'm also trying to get my house in order if I get stuck here.
The new OSHA guidelines, for those that care and whose employers haven't posted those, and, the new Community Mitigation Strategies, including the 12 weeks of school closure, which parents will care about; may be new wedges.
It is very unethical of those asking for "volunteers" to not give full disclosure, so, there's the whole churches, funeral homes, Red Cross, local organizations, first responders on the street go-round again; maybe things will be different.
The people's attitudes and reactions the past couple years are more discouraging than the virus. I admit I hadn't thought that would be the case, initially.

Revere, what you say, repeated below, is 100% "safe". We trust you will not place society at risk due to an observation that is not scientifically defensible. That point is indisputable.

There is another indisputable fact. at Phase 6 highly virulent pandemia, humans will be unable to adapt quickly enough for even the large minority to survive medically unimpacted (given a CFR 30%); and that will be a society wrecker.

We can parse my fact statement, slice it & dice it, and reshape it; however, the kernal of the message is that just as you don't know now, you and I know that if and when Phase 6 materializes, in Osterholm's words, "We're screwed."

The additional fact is that the public will do nearly nothing unless they believe themselves to be at risk. For them to believe that, they need "something". So far, the PH efforts are, we both agree, sadly lacking. The public sees no evil requiring a response at this time, and they don't hear Leavitt or Osterholm, or Nabarro. So, as we observe, little gets done and of the little, it's pretend and paltry, like the CDC dress rehearsal last month (cancelled in part due to "snow day" reality which superceded the "reality" of their very expensive event.

My point, and yours, is that what PH is doing in this area ain't workin' at a pace faster than a very slow walk.

My further point is that irrespective of human incapacity to state with 100% assurance that Phase 6 approaches within a time window which militates prep action now, to achieve a prep sufficient to encounter a 2% CFR (or greater), the public needs a stimulus different than what PH has served up.

Ergo, no different stimulus, no different response. And, again, no different response prior to Phase 6 arrival is a society wrecker.

Probably this decision is as it was in the past, a political decision, irrespective of PH fact. And therein lies the rub as politically it's unjustifiable in the face of competing demands for scarce resources, and it's unjustifiable because there is no technological capacity to measure imminence.

The consequences are, shall we say, unavoidable.

Revere:>

GR: I don't bet on things like this. I will tell you my opinion on this matter. In my view, the odds are that there are not 3 people a day with H5N1 in Egypt at this moment. If there were I would be very concerned but I don't rule it out. At this point I'd say it isn't. This isn't a contest or a game. If it is H5N1 we'll know soon enough and we'll have to act accordingly. Please stop pestering me about this. If you guessed right, you guessed right and I guessed wrong. If I guessed right, it doesn't matter in the least to me personally. I don't hear noise. I don't know what I hear. If I could distinguish noise from signal then it would be different, but I can't. And I don't think you can either.

Now let's let this go and wait to see what happens.

Posted by: revere | March 5, 2007 05:40 PM

GR: Having lived through the Swine Flu debacle and its aftermath, which we are living with now, I think I have a good appreciation for what happens when you pull the trigger and there is a blank in the gun. The harm that was done to credibility for warning in public health is incalculable and you are seeing some of the consequences. So it isn't a no brainer by any means. That is the reason public health people are cautious, and rightly so. The problem, as always, is finding the balance in the face of great uncertainty. My judgment -- my true professional judgment -- is that it is not time to pull the trigger on warning people that a pandemic is imminent. You disagree.

GR, unless there is someone standing behind you with a gun, I fail to see how the reveres are "pestering" you. Are you being forced to comment on this blog?

Thx, Revere. I sincerely appreciate and trust your professional judgment. I've watched your thinking on this for nearly 3 years, and you've been a white hat guy on every issue that's arisen save this most recent re: the difficulty of determining "imminence" as it goes to whether or not there will be adequate lead time to prep the society for Phase 6.

I don't know if it's imminent. I want someone else to tell me. I also don't know what "imminent" means; again, I need someone else to tell me when it is. I'll look for the announcement here in EffectMeasure.

So, if a revere would define what's "imminent", I'll go back to my own interests.

Melanie, I too fail to see how the reveres are "pestering" me. At last, we agree. The response was to revere's sentence, "Please stop pestering me about this." Revere posted that, not me. So, you and I agree, don't we?

MRK - Frustration leads to lapses in judgement. I will therefore, refrain from saying too much.

BF is concerning. But nearly everything you say is conjecture. Following your posts is difficult enough, but debating them is a sidestep into an altered reality.

As pointed out, GR saying there are 3 cases a week is unsubstantiated. Even if it was substantiated, there is no evidence anything has changed.

And you seem to gloss over the fact that should H5N1 go pandemic, we don't know how pathogenic it will be. Your making assumptions that it has to be 1918 equivalent or worse.

I've already said more than I intended. My concern has always been, to keep things in perspective. I've been admiring Revere's ability to do so, especially as of late. Because of the heavy bias of (dare I say) alarmists of other boards, I get my news here. Revere has done a great job of sorting the wheat, from the chaff.

For any of us to be productive in dealing with the BF threat, we must remain credible. Whether is spreading the word. interpreting recent events or even prepping ourselves, we must not over react. People become complacent when threats don't materialize. It makes sense to not over emphasize the threat, at this point.

Patch-I learned in the military that you were always to assume the worst has happened and to start coming up with plans on how to mitigate and take the offensive. I gloss over nothing. I just assume that the worst will happen and that this will go fully military situation within say two or three weeks of it breaking out, if it does. I also am assuming HPAI rather than mild as their so far very stupid 5% assumption (or maybe deliberate) projections are being put out. It would have to slide an incredible amount to the rear to get to 5% and even my virologist drinking buddy is damned shitting worried. He tells me about every other day that if it even broke down by 1/2 of the current 83% we would see chaos on an enormous scale. I buy that argument. Is it based in science. Nope. Might it be? Maybe a little later.

This IS a credible threat of enormous proportions and just about every civilized world is engaged now in preparation for it on various scales of ability. Some are laying out there defenseless now and they will be the ones that take the largest hit by percentages.. Nigeria, Ethiopia, Chad, Uganda all are just waiting for it to arrive. Its kind of like pulling the pin on a hand grenade, science tells you it should go off, but it might not. I choose not to be around when its pulled.

If you put plugs in your ears, and blinders on you might not hear or see any evil. Just remember not to inhale if you do. And remember Patch... I always agree you might be right. But if you are wrong then its a moot point.

MRK - You make a lot of assumptions.

First, you assume a full military situation is a bad thing. Our military is on our side, right? Even in a quarantine arrangement, the military may not break down to the scenes we see in movies. Second, you assume HPAI, with high CFR's. I know we are worried about that, but that does not make it so. As for your drinkin' buddy perhaps he brings it up every other day because you are asking? And if he's sane, he SHOULD be worried about a fraction of the current CFR, especially when you start talking a 40%+ CFR. Should I be surprised that that rate would cause chaos? Finally, you admittedly fail to base any of these assumptions on science.

You go on to say, after making these assumptions based on no scientific evidence (by your own admission), that it's a credible threat, although I'm not sure how. You say every country in the civilized world is prepping, although this seems to be a new position of yours. And finally, I'm not sure what you expect the poorest countries in the world to do about a "threat" that at this point anyway, barely rates as a blip on their mortality charts, compared to the many diseases that curse them in much larger numbers every single day. A threat by the way, where the best course of action, is to take and dispose of some of their meager amounts of food.

And you close every post, with epitaphs of the gloom and doom that will surely follow anyone not thoroughly entrenched in your view.

I again re-iterate. To remain credible, we must remain balanced in our views and opinions. We must refrain from the drama and follow the Revere's example of looking at the problem logically and realistically.

Patch-You havent got a clue what could happen if the military takes over in a situation like this. Katrina cowboys with M-16's running around trying to stop food riots and looting? Yeah Patch I guess they are on our side. Thank God they at least will have orders to do whatever it is that they will be doing.

As for your "credible threat" comment. If there is one active case on this planet then its a credible threat. You apparently dont read anything from Nbarro, Webster, Webby etc. who all seem to think that this is coming... based upon what? No hard science! Every country in the civilized world IS prepping Patch, or you dont read that either. Its not enough but they are. All of them are doing it in various levels of capability and/or willingness because someone in their government thinks its coming. Your blip as you put it unlike the others dont generally have the capability to remove us from the planet in large number except in long duration waves. The last one to do that was Smallpox. TB is cranking out there, but even then it doesnt kill in the numbers we are talking about here.

Epitaph of doom and gloom? Stick to your plan, I'll stick to mine. Lets see who comes out of the tunnel if it comes Patch. I think you just like to stick it to people who dont follow YOUR opinion of what is credible or not. I fully agree with CRFull that if this stuff wasnt coming it would be going away. You find that intolerable in your presentation of what is credible. Doesnt fit the mold of your science. Well guess what it currently doesnt mine either, but I am preparing like it is.

Talking about the normal killers out there is BS in the face of this stuff. Adaptive mutation and a novel virus in history seem to have changed the way things worked in a very bad way. You are right. There is NO current science that indicates that it is easily transmissible. I speak to my friend about every day as we skydive together and since I have a plane it always comes up. Here is a news flash Patch... He thinks its coming and he is 58 years old and been a virologist for pushing on 25 years. He is the first one to say there is nothing to positively show its coming, but he fully believes it is. So you can agree, or disagree.

What do the people will do when everyone says oh its not a problem, then suddenly crosses this planet in under six weeks? Lets do hope that you are right. Man I hope you are. I am in a 60/40 mode right now that it will. Mostly because these governments that are already cash strapped are spending serious money on it. Those that dont have money have a plan and their hands out for someone else to fund. Therein lies the biggest reason it would spread. Me I am budgeting money every month for no other reason that the graphs that the end of days section of the UN posted up. Natural disasters, BF, other pandemics, tornadoes. Buffet wants to know where you are gonna go when the volcano blows?

One other thing... You said you wanted a copy of Websters comments here in town and were calling what I said into question. I offered it up the next day to include pictures, and the text from a scan. You chose not to take me up on it. I am not into providing information unless someone requests it. You did and when offered, chose not to get it. I personally think you like to snipe Patch. For you to remain credible you must follow up with what you say.

Doom and gloom. I am the happiest and cheeriest doomsayer out there. I can find funny in a hydrogen bomb-Just ask Dr. Strangelove and they made money off of it. 50 cases of H2H Patch is all its going to take out of 6.5 billion people. What are the odd that it wont? What are the odds that they could contain it? I fully assert you could be right but the one thing you dont have is CFR and number of cases thats going down. Look at the old H1N1 graphs from NYC. Pretty close for the initial runs. I will point out one more thing and then just let it go. The science of what would happen if it did come in HIgh Path isnt in question. Revere is right about the government being Swine Flu gun shy. The alarm went out, it turned out to be a false alarm, people got vaccinated for a virus that never showed and many became ill and left partially paralyzed. Okay, so it didnt happen. What if it had?

I read much of what Nabarro, Webster and others (including Osterholm who you didn't mention) say and write. I don't limit my information only to those however. There are experts out there who are less convinced than those you mention. If you keep an open mind, you might find value in their information as well. Dr. Gary Butcher is one.

If you think I believe this is all smoke and mirrors, you are grossly mistaken. I am largely concerned. The difference for me I believe, is I temper my concern with the reality of the situation as it exists, while considering possibilities, verses only what could happen and how bad it could be.

Clearly you and I have more than a passing interest in BF. I think we probably agree on more than we disagree on. But I think talking about what we know and where we are now, is as important (in fact more so) than all the terrible things that could happen. Fixing problems that don't exist is what got us into the unsuccessful Swine Flu program.

That's why I maintain, keeping things in prospective is important.

I apologize for not following up with my request for Websters presentation which you offered. My free time is limited and as posts move off the front page, I fail to go back and look. I appreciate your offer.

Patch, Dr. Butcher is a well known flu skeptic, but his ties to the poultry industry make his views suspect. I'm more impressed by the change of mind made by Dr. Arnold Monto, who was openly and fervently skeptical when I met him over a year ago. At the last conference where I saw him, that skepticism was gone. I respect the views of the vets, and wish more of them could get a hearing in the MSM, but Arnie is an infectious disease epidemiologist and his views carry more weight with me.

Thanks Melanie, he was one I was not familiar with.

I agree, vets are on the front line right now. Dr. Butcher does have the poultry industry ties, but he is also a leading expert in poultry epidemiology. I understand your point, but it's hard to brush off his opinion entirely.

As I said, varying opinions give us more to think about and a greater perspective. From Niman to Butcher and from 1918 to present, there is a lot to think about. My point was, not to concentrate only on one level. Again, perspective. Thanks

Patch, the goal is as you say, "not to concentrate only on one level." Perspective does not mean that one is not continuously testing hypotheses, just to see what the look like.

The PH community got its tit in the wringer over the prior debacle. So, they're gunshy to even venture a thought; look at what Revere is willing to do just to not venture a hypothesis other than we don't have enough info to know.

Your desire for perspective leaves those of us who want to test out the idea-toys wandering in the store and hearing at every turn, "Look. Don't touch". It dudn't work that way in real life.

GaudiaRay, you misrepresent Revere.

He said _he_ won't touch. He said his job is to watch the whole store, hoping to noticing the one toy which turns into a monster. He can't do that if he is engrossed playing with one.

He invited, he urged, _you_ to touch, to play with whichever toy captures your imagination.

Greg, what part of this posting involves dialogue with Revere? Hint: None, Zero, Nada, Zip. I choose Zero.
>Patch, ...Your desire for perspective leaves those of us who want to test out the idea-toys wandering in the store and hearing at every turn, "Look. Don't touch". It dudn't work that way in real life.<

Greg, after reading this, what's your point?

Do appreciate I get the message that you're a bullet supporter "Yellow Dog" responder to Revere's postings. I'm envious that you're as you are vis a vis Revere.

My posting was directed to Patch, not to Revere. I was addressing his thought that we should have perspective. I was exploring the definition of perspective; the way to perceive and triage the breadth of PH issues. If I failed to get the thought across to Patch, my apologies.

I'm appreciative of your decision to restate Revere's viewpoint. He expressed his idea well, earlier on in this thread. I was exploring the topic further with Patch.